Approach to the care of long-term testicular cancer survivors
- Clair J Beard, MD
Clair J Beard, MD
- Associate Professor of Radiation Oncology
- Harvard Medical School
- David J Vaughn, MD
David J Vaughn, MD
- Professor of Medicine
- Abramson Cancer Center of the University of Pennsylvania
- Section Editors
- Larissa Nekhlyudov, MD, MPH
Larissa Nekhlyudov, MD, MPH
- Section Editor — Cancer Survivorship
- Associate Professor
- Department of Medicine
- Brigham & Women’s Hospital
- Harvard Medical School
- Patricia A Ganz, MD
Patricia A Ganz, MD
- Section Editor — Cancer Survivorship
- UCLA Schools of Medicine and Public Health
- Jonsson Comprehensive Cancer Center
Testicular cancer is the most curable solid tumor and the most common malignancy in men between the ages of 18 and 35. The overall survival rate after diagnosis and treatment of testicular cancer exceeds 96 percent at 10 years. Following treatment for testicular cancer, oncologic follow-up is guided in part by the probability of relapse over time. Although most relapses occur within the first five years, late recurrences can occur.
During the period of oncologic follow-up, after active therapy or any time thereafter, patients with a history of testicular cancer may develop symptoms that affect quality of life or have abnormal findings on clinical examination . Both primary care clinicians and oncologists may be challenged with questions related to whether or not these symptoms or findings are due to prior treatment.
Because of the young age at which men with testicular cancer are diagnosed and success in treatment of testicular cancer, issues of cancer survivorship evolve as men mature. This topic will cover late treatment-related complications in testicular cancer survivors. The discussion is intended for the management of patients who have completed the active phase of cancer therapy and have transitioned to receiving almost all of their care from their primary care clinician. Acute treatment-related toxicity and posttreatment follow-up of men treated for testicular cancer are discussed in more detail separately. (See "Treatment-related toxicity in men with testicular germ cell tumors" and "Posttreatment follow-up for men with testicular germ cell tumors".)
A general overview of cancer survivorship is discussed separately. (See "Overview of cancer survivorship care for primary care and oncology providers".)
OVERVIEW OF TREATMENT FOR TESTICULAR CANCER
Testicular cancer affects fewer than 9000 men in the United States each year and usually presents as a nodule or painless swelling of one testicle, which may be noted incidentally by the patient or by his sexual partner [2,3]. The vast majority of testicular cancers are germ cell tumors, which are classified as either seminomas or non-seminomatous germ cell tumors (NSGCTs). Approximately 90 percent are detected with low-stage disease (stage I to IIB) (table 1 and table 2), and most (60 to 80 percent) will have clinical stage I disease .
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- OVERVIEW OF TREATMENT FOR TESTICULAR CANCER
- Primary surgery
- Fertility preservation
- Primary treatment
- Resection of residual disease following chemotherapy
- FOLLOW-UP POSTTREATMENT
- ORGAN-SPECIFIC EFFECTS OF TREATMENT
- Cardiovascular disease
- - Metabolic syndrome
- Gastrointestinal disorders
- Pulmonary toxicity
- - Bleomycin-induced lung injury
- - Infertility
- - Sexual dysfunction
- Renal impairment
- Peripheral neuropathy
- Non-traumatic osteonecrosis
- SECONDARY MALIGNANCIES
- Solid tumors
- Skin cancers
- Hematologic malignancies
- Contralateral testicular cancer
- CHRONIC FATIGUE
- PSYCHOLOGIC DISTRESS
- SURVIVORS AFTER SALVAGE THERAPY
- FOLLOW-UP FOR LONG-TERM SURVIVORS OF TESTICULAR CANCER
- SUMMARY AND RECOMMENDATIONS